title: Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy.
abstract: BACKGROUND
  Self-management of complex medication regimens for chronic illness is challenging for many older adults.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology.
  
  
  METHODS
  This study used a randomized controlled trial with three arms and longitudinal outcome measurement.
  
  
  METHODS
  Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area.
  
  
  METHODS
  All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months.
  
  
  RESULTS
  After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons.
  
  
  CONCLUSIONS
  Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.
authors.affiliation: College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004-0698, USA. Karen.Marek@asu.edu
authors.forename: Karen Dorman
authors.initials: KD
authors.lastname: Marek
authors.forename: Frank
authors.initials: F
authors.lastname: Stetzer
authors.forename: Polly A
authors.initials: PA
authors.lastname: Ryan
authors.forename: Linda Denison
authors.initials: LD
authors.lastname: Bub
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Adams
authors.forename: Andrea
authors.initials: A
authors.lastname: Schlidt
authors.forename: Rachelle
authors.initials: R
authors.lastname: Lancaster
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy / Q000451:nursing; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015146:Midwestern United States; D009732:Nursing Care / Q000458:organization & administration*; D015397:Program Evaluation; D012648:Self Care; D012651:Self Medication / Q000451:nursing*